Provider Demographics
NPI:1841659281
Name:SADRAKULA, ANDREA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:SADRAKULA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18331 LOST KNIFE CIR APT 204
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-0310
Mailing Address - Country:US
Mailing Address - Phone:609-533-5872
Mailing Address - Fax:
Practice Address - Street 1:101 LAKEFOREST BLVD STE 302
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2629
Practice Address - Country:US
Practice Address - Phone:301-389-5026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-13
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD231251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical